Li Ruowei, Jewell Sandra, Grummer-Strawn Laurence
Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA.
Am J Clin Nutr. 2003 Apr;77(4):931-6. doi: 10.1093/ajcn/77.4.931.
Maternal obesity has been associated with poor lactation in animal models, but the results of related research in humans are inconclusive.
We tested the hypothesis that women who are obese before pregnancy or who gain excessive weight during pregnancy are less likely to initiate and maintain breast-feeding than are their normal-weight counterparts.
We analyzed 124 151 mother-infant pairs from the Pediatric Nutrition Surveillance System and the Pregnancy Nutrition Surveillance System. Body mass index (BMI) before pregnancy and gestational weight gain were categorized according to guidelines from the Institute of Medicine. Multiple logistic regression was used to identify the association between maternal obesity and breast-feeding initiation (n = 51 329), and multiple linear regression was used to examine the effect of maternal obesity on breast-feeding duration among women who initiated breast-feeding (n = 13 234).
Regardless of gestational weight gain, obese women were less likely to initiate breast-feeding than were women with a normal BMI before pregnancy who also gained the recommended weight during pregnancy. Maternal BMI before pregnancy and gestational weight gain were each independently associated with duration of breast-feeding. Women who were obese before pregnancy breast-fed approximately 2 wk less than did their normal-weight counterparts, and women who either failed to reach or exceeded the recommended gestational weight gain breast-fed approximately 1 wk less than did those who gained the recommended gestational weight.
Both obesity before pregnancy and inadequate weight gain during pregnancy have a negative effect on breast-feeding practice. Women who are obese before pregnancy or who gain inadequate weight during pregnancy need extra support for breast-feeding.
在动物模型中，母体肥胖与泌乳不佳有关，但人类相关研究结果尚无定论。
我们检验了这样一个假设，即孕前肥胖或孕期体重增加过多的女性比体重正常的女性更不容易开始并维持母乳喂养。
我们分析了来自儿科营养监测系统和孕期营养监测系统的124151对母婴。根据医学研究所的指南对孕前体重指数（BMI）和孕期体重增加情况进行分类。采用多因素逻辑回归分析来确定母体肥胖与母乳喂养开始之间的关联（n = 51329），采用多因素线性回归分析来研究母体肥胖对开始母乳喂养的女性的母乳喂养持续时间的影响（n = 13234）。
无论孕期体重增加情况如何，肥胖女性比孕前BMI正常且孕期体重增加也达推荐值的女性更不容易开始母乳喂养。孕前母体BMI和孕期体重增加各自独立与母乳喂养持续时间相关。孕前肥胖的女性母乳喂养时间比体重正常的女性大约少2周，孕期体重增加未达或超过推荐值的女性母乳喂养时间比孕期体重增加达推荐值的女性大约少1周。
孕前肥胖和孕期体重增加不足均对母乳喂养行为有负面影响。孕前肥胖或孕期体重增加不足的女性在母乳喂养方面需要额外的支持。
